Abstract
Coarctation of the aorta is best displayed from the suprasternal or high parasternal window. 2D imaging differentiates between discrete stenosis and tubular hypoplasia of the aortic arch. Colour Doppler helps to differentiate normal flow from accelerated turbulent flow in the region of the stenosis. Patency of the ductus arteriosus can be displayed in the left parasternal view. In the neonatal period, as long as the ductus arteriosus is widely patent, absence of accelerated flow in the aortic arch or isthmus during colour Doppler interrogation is completely insufficient to exclude severe coarctation. In the presence of a closed ductus arteriosus, PW and CW Doppler show accelerated flow across the stenosis. Severe coarctation is characterized by accelerated flow velocities both in systole and diastole resulting in a sawtooth flow pattern, while exclusive acceleration of systolic flow is found in mild to moderate stenosis. With the Bernoulli equation, the systolic pressure gradient across the stenosis can be estimated. In the presence of accelerated flow proximal to the stenosis, the expanded Bernoulli equation has to be applied. In neonates and infants, additional flow measurements of the aortic arch and isthmus flow measurements in pre- and poststenotic reference arteries are helpful for confirmation of the diagnosis: prestenotic reference arteries are the cerebral arteries; poststenotic reference arteries are the abdominal arteries. In severe coarctation with closed ductus arteriosus, significantly reduced flow velocities are found in the abdominal arteries, while in contrast to healthy infants, peak systolic flow velocities in the cerebral arteries are significantly higher than peak systolic flow velocities in the coeliac artery.
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21.1 Electronic Supplementary Material
Video 21.1
The parasternal long-axis view in a newborn with severe coarctation reveals some left ventricular hypertrophy and severely impaired function of the left ventricle (AVI 9586 kb)
Video 21.2
The parasternal short-axis view in another newborn with critical coarctation shows decreased left ventricular function and dilatation of the right ventricle. Leftward shift of the interventricular septum and abnormal septal motion indicate significant elevation of right ventricular pressure (AVI 12483 kb)
Video 21.3
The apical four-chamber view (same patient as in Video 21.2) shows significant dilatation of the right atrium and right ventricle as well as severely compromised left ventricular function (AVI 6815 kb)
Video 21.4
The suprasternal long-axis view in a newborn with isthmic coarctation shows hypoplasia of the aortic arch starting distal to the left common carotid artery (AVI 27885 kb)
Video 21.5
The suprasternal long-axis view in another newborn with aortic coarctation shows moderate hypoplasia of the aortic arch beginning distal to the innominate artery (AVI 10107 kb)
Video 21.6
Colour Doppler (same patient as in Video 21.5) shows antegrade perfusion of the aortic arch and reveals some acceleration of flow distal to the left subclavian artery (AVI 1571 kb)
Video 21.7
Colour Doppler in the suprasternal long-axis view of a newborn shows a very tight distal coarctation, which is characterized by a jet with continuous flow in the area of stenosis (AVI 2536 kb)
Video 21.8
The ductal view shows the intraluminal shelf of severe coarctation in a newborn. Similar to the case in Video 21.7, the isthmic stenosis is located quite distally (AVI 14279 kb)
Video 21.9
Colour Doppler in the ductal view (same patient as in Video 21.7) reveals continuous flow throughout the cardiac cycle across the stenosis (AVI 4922 kb)
Video 21.10
Colour Doppler in the suprasternal long-axis view of a newborn with severe coarctation reveals a circumscript stenosis located distal to the left subclavian artery and proximal to the ductus arteriosus, which exhibits minimal residual patency (AVI 2961 kb)
Video 21.11
The ductal view in a newborn with transposition and VSD shows hypoplasia of the aortic arch distal to the left common carotid artery. In addition there is significant stenosis of the aortic isthmus. The patent ductus arteriosus connects the pulmonary artery to the descending aorta just distal to the isthmic coarctation (AVI 5643 kb)
Video 21.12
Despite hypoplasia of the aortic arch and severe isthmic coarctation (same patient as in Video 21.11), colour Doppler displays laminar flow across the aortic arch and aortic isthmus. Right to left shunting across the ductus arteriosus is apparent in systole, while there is left to right ductal shunting in diastole (AVI 1664 kb)
Video 21.13
The suprasternal long-axis view in an infant shows a normal-size aortic arch following resection of coarctation and end-to-end anastomosis of the aorta. The sutures of the anastomosis are visible distal to the left subclavian artery (AVI 6979 kb)
Video 21.14
Colour Doppler shows laminar flow (same patient as in Video 21.14) across the site of anastomosis (AVI 1949 kb)
Video 21.15
The parasternal short-axis view in a 9-year-old patient with severe isthmic coarctation does not reveal significant hypertrophy of the left ventricle (AVI 8436 kb)
Video 21.16
Colour Doppler in the suprasternal long-axis view of a 16-year-old patient appears normal and fails to display the severe isthmic coarctation, which is present in this patient (same patient as in Videos 21.18 and 21.19) (AVI 2752 kb)
Video 21.17
The suprasternal long-axis view in a 9-year-old patient (same patient as in Video 21.15) shows normal diameters of the aortic arch. Colour Doppler reveals severe coarctation distal to the left subclavian artery, while the descending aorta is not well displayed in this view (same patient as in Video 21.15) (AVI 3492 kb)
Video 21.18
Colour Doppler in the ductal view of a 16-year-old patient (same patient as in Videos 21.16 and 21.19) shows some reduction of aortic diameter and possible acceleration of flow in the aortic isthmus (AVI 1027 kb)
Video 21.19
Placement of the patient in a left lateral position (same patient as in Videos 21.16 and 21.18) results in improved visualization of the aortic isthmus revealing acceleration of flow and a continuous flow profile in the isthmic region (AVI 1900 kb)
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Hofbeck, M., Deeg, KH., Rupprecht, T. (2017). Coarctation of the Aorta. In: Doppler Echocardiography in Infancy and Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-42919-9_21
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DOI: https://doi.org/10.1007/978-3-319-42919-9_21
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